The value of hyperactive curiosity

For a little yellow flower, it's ignited a huge debate. Believe the
headlines and St John's wort won't help hyperactive kids, but last
week's study asks more questions than it answers. It's time to put
funding disclosures in the dock.

The herb is typically used against depression and anxiety, so using
it against hyperactivity and inattentiveness in children, something
never tested before, does raise questions.
But the small print at the end of the article raises questions
about the validity of results from medical researchers heavily
funded by the pharmaceutical industry, researching dietary
supplements and food and reporting null results.
Disclosing sources of funding in journals is necessary and not an
admission of anything other than funding. But at what point do
funding disclosures become conflicts of interest, and at what point
do conflicts of interest turn into something that essentially
undermines the science? Is there a cut-off point?
If there isn't, there should be.
To understand this issue we must first understand the study.
Fifty-four children and adolescents with Attention Deficit
Hyperactivity Disorder (ADHD) were randomly assigned to receive a
daily supplement of 300 mg of St. John's wort (Hypericum
perforatum​) standardised to 0.3 per cent hypericin (a standard
dose) or placebo for eight weeks.
The researchers, publishing their results in the prestigious
Journal of the American Medical Association​ (JAMA), found
no significant differences between the groups with respect to
inattentiveness or hyperactivity.
Einstein once said that the important thing is not to stop
questioning because curiosity has its own reason for existing.
Let's follow Albert's advice and ask some questions.
Why was this study was even performed, given the complex root
causes of ADHD? I am not aware of any other studies that have
previously linked St John's wort to ADHD benefits. (A quick search
on PubMed shows no others.)
And let's ask about the 'herbal' given to the children - the
researchers admit that the actual dose in the supplements was less
than half of what it was supposed to be, and that a higher
(correct) dose may be of benefit.
This is a nice admission buried in the article and missed by the
consumer press.
So, let me boldly summarise: they tested a product that contained
reduced levels of the active compounds, a product unlike others on
the shelves, but still concluded that St. John's wort is
ineffective. This is unacceptable.
For a wider food industry example, you wouldn't test white
chocolate (which does not contain the heart healthy flavonoids) and
conclude that all chocolate offers no cardiovascular benefits,
would you?
Disclosure ​
In terms of disclosure, it is not a situation as simple as,
"you can't question my results. I was honest and transparent
with my funding, therefore my conclusions are honest and
accurate."​ Erm, no. Scientists should not get off the hook so
easily.
Get the magnifying glass out and look at the small print at the end
of the article. One of the researchers - Dr. Joseph Biederman,
affiliated with Harvard University - discloses he has received
funding from a number of pharmaceutical companies, and quite an
impressive list it is.
The list (take a deep breath because this will take a while)
includes: Alza, AstraZeneca, Bristol-Myers Squibb, Eli Lilly,
Janssen Pharmaceuticals, McNeil, Merck, Organon, Otsuka, Shire,
Novartis, UCB Pharma, Noven, Neurosearch, Pfizer, Pharmacia, the
Prechter Foundation, the Stanley Foundation, and Wyeth. Add on
additional funding from the National Institute of Mental Health,
the National Institute of Child Health and Human Development, the
National Alliance for Research on Schizophrenia and Depression, and
the National Institute on Drug Abuse and you have what Oliver Hardy
used to call "a nice mess".
Situations like this will only fan the flames of the conspiracy
theory bonfire that Big Pharma is out to get Little Dietary
Supplements, but you don't need paranoia to question the
conclusions of the JAMA study - this is common sense.
Journals have fought hard to ensure full disclosure of funding.
Indeed, JAMA has led the way and its editor-in-chief, Dr. Catherine
DeAngelis, has written editorials emphasising that all authors are
now required to report all potential conflicts. I applaud this and
see Dr. DrAngelis' comments as the benchmark for all
journals.
I contacted JAMA to ask for Dr. DeAngelis' views on the St John's
wort study and the issue of cut-off points, but I had not received
an answer before this article was published.
But regardless of the journal's stance, the damage from the recent
study may already be done: People who are considering or already
taking St John's wort for depression, a condition with a wealth of
science to back it up, may now be questioning its overall
effectiveness.
The industry, particularly in the US, has widely criticised the
study, but how much of that reaction has fallen on deaf ears?
The lessons are there to be learnt, but only if people ask the
right questions.
Stephen Daniells is the science editor for NutraIngredients.com
and FoodNavigator.com. He has a PhD in chemistry from Queen's
University Belfast and has worked in research in the Netherlands
and France. ​
If you would like to comment on this article, please email
stephen.daniells'at'decisionnews.com​